Understanding the sources of cortico-cortical paired associative stimulation (ccPAS) variability: Unraveling target-specific and state-dependent influences

Time-dependent enhancement of corticospinal excitability during cortico-cortical paired associative stimulation of the hV6A-M1 network in the human brain

Cortico-cortical paired associative stimulation (ccPAS) is a powerful transcranial magnetic stimulation (TMS) protocol thought to rely on Hebbian plasticity and known to strengthen effective connectivity, mainly within frontal lobe networks. Here, we expand on previous work by exploring the effects of ccPAS on the pathway linking the medial posterior parietal area hV6A with the primary motor cortex (M1), whose plasticity mechanisms remain largely unexplored. To assess the effective connectivity of the hV6A-M1 network, we measured motor-evoked potentials (MEPs) in 30 right-handed volunteers at rest during dual-site, paired-pulse TMS. Consistent with previous findings, we found that MEPs were inhibited when the conditioning stimulus over hV6A preceded the test stimulus over M1 by 12 ms, highlighting inhibitory hV6A-M1 causal interactions. We then manipulated the hV6A-M1 circuit via ccPAS using different inter-stimulus intervals (ISI) never tested before. Our results revealed a time-dependent modulation. Specifically, only when the conditioning stimulus preceded the test one by 12 ms did we find a gradual increase of MEP amplitude during ccPAS, and excitatory aftereffects. In contrast, when ccPAS was applied with an ISI of 4 ms or 500 ms, no corticospinal excitability changes were observed, suggesting that temporal specificity is a critical factor in modulating the hV6A-M1 network. These results suggest that ccPAS can induce time-dependent Hebbian plasticity in the dorsomedial parieto-frontal network at rest, offering novel insights into the network's plasticity and temporal dynamics.

Repeated spaced paired-associative stimulation to the parietal-motor pathway maintains corticomotor excitability in older adults

INTRODUCTION

Cortical paired associative stimulation (cPAS), repeated at spaced intervals and applied to the primary motor cortex (M1) and posterior parietal cortex (PPC), has a dose-dependent effect on corticomotor excitability in young adults. The present study investigated whether aging affects this additive (nonhomeostatic) metaplasticity by performing the same manipulation in a sample of older adults.

METHODS

In the multi-dose cPAS condition, three consecutive sessions of the Hebbian-plasticity-induction cPAS protocol were administered with a 50-minute interval between sessions. In the single-dose control cPAS condition, one session of the Hebbian-plasticity-induction cPAS protocol was followed by two sessions of a control non-Hebbian cPAS protocol. We measured motor-evoked potentials (MEPs) before and after each cPAS session.

RESULTS

Compared to a single dose of cPAS, the multi-dose cPAS protocol prevented the reduction in MEP amplitude, resulting in relatively greater corticomotor excitability following the Hebbian procedures. We did not find evidence for an increase in MEP amplitude after the repeated, spaced Hebbian-plasticity-induction cPAS protocol from baseline levels, suggesting reduced neuroplasticity in older adults compared to young adults.

CONCLUSION

Repeated spaced paired-associative stimulation to the parietal-motor pathway maintains corticomotor excitability in older adults.

SIGNIFICANCE

These findings provide insight into age-related differences in neuroplastic capacity in healthy humans.

You Are as Old as the Connectivity You Keep: Distinct Neurophysiological Mechanisms Underlying Age-Related Changes in Hand Dexterity and Strength

BACKGROUND

Aging can lead to a decline in motor control. While age-related motor impairments have been documented, the underlying changes in cortico-cortical interactions remain poorly understood.

METHODS

We took advantage of the high temporal resolution of dual-site transcranial magnetic stimulation (dsTMS) to investigate how communication between higher-order rostral premotor regions and the primary motor cortex (M1) influences motor control in young and elderly adults. We assessed the dynamics of connectivity from the inferior frontal gyrus (IFG) or pre-supplementary motor area (preSMA) to M1, by testing how conditioning of the IFG/preSMA affected the amplitude of motor evoked potentials (MEPs) induced by M1 stimulation at different temporal intervals. Moreover, we explored how age-related changes in premotor-M1 interactions relate to motor performance.

RESULTS

Our results show that both young and elderly adults had excitatory IFG-M1 and preSMA-M1 interactions, but the two groups' timing and strength differed. In young adults, IFG-M1 interactions were early and time-specific (8 ms), whereas in older individuals, they were delayed and more prolonged (12-16 ms). PreSMA-M1 interactions emerged early (6 ms) and peaked at 10-12 ms in young individuals but were attenuated in older individuals. Critically, a connectivity profile of the IFG-M1 circuit like that of the young cohort predicted better dexterity in older individuals, while preserved preSMA-M1 interactions predicted greater strength, suggesting that age-related motor decline is associated with specific changes in premotor-motor networks.

CONCLUSIONS

Preserving youthful motor network connectivity in older individuals is related to maintaining motor performance and providing information for interventions targeting aging effects on behavior.

Investigating the effects of cortico-cortical paired associative stimulation in the human brain: A systematic review and meta-analysis

Recent decades have witnessed a rapid development of novel neuromodulation techniques that allow direct manipulation of cortical pathways in the human brain. These techniques, known as cortico-cortical paired stimulation (ccPAS), apply magnetic stimulation over two cortical regions altering interregional connectivity. This review evaluates ccPAS's effectiveness to induce plastic changes in cortical pathways in the healthy brain. A systematic database search identified 41 studies investigating the effect of ccPAS on neurophysiological or behavioural measures, and a subsequent multilevel meta-analysis focused on the standardized mean differences to assess ccPAS's efficacy. Most studies report significant neurophysiological and behavioural changes from ccPAS interventions across several brain networks, consistently showing medium effect sizes. Moderator analyses revealed limited influence of experimental manipulations on effect sizes. The multivariate approach and lack of small-study bias suggest reliable effect estimates. ccPAS is a promising tool to manipulate neuroplasticity in cortical pathways, showing reliable effects on brain cortical networks. Important areas for further research on the influence of experimental procedures and the potential of ccPAS for clinical interventions are highlighted.

Driving Hebbian plasticity over ventral premotor-motor projections transiently enhances motor resonance

BACKGROUND

Making sense of others' actions relies on the activation of an action observation network (AON), which maps visual information about observed actions onto the observer's motor system. This motor resonance process manifests in the primary motor cortex (M1) as increased corticospinal excitability finely tuned to the muscles engaged in the observed action. Motor resonance in M1 is facilitated by projections from higher-order AON regions. However, whether manipulating the strength of AON-to-M1 connectivity affects motor resonance remains unclear.

METHODS

We used transcranial magnetic stimulation (TMS) in 48 healthy humans. Cortico-cortical paired associative stimulation (ccPAS) was administered over M1 and the ventral premotor cortex (PMv), a key AON node, to induce spike-timing-dependent plasticity (STDP) in the pathway connecting them. Single-pulse TMS assessed motor resonance during action observation.

RESULTS

Before ccPAS, action observation increased corticospinal excitability in the muscles corresponding to the observed movements, reflecting motor resonance in M1. Notably, ccPAS aimed at strengthening projections from PMv to M1 (PMv→M1) induced short-term enhancement of motor resonance. The enhancement specifically occurred with the ccPAS configuration consistent with forward PMv→M1 projections and dissipated 20 min post-stimulation; ccPAS administered in the reverse order (M1→PMv) and sham stimulation did not affect motor resonance.

CONCLUSIONS

These findings provide the first evidence that inducing STDP to strengthen PMv input to M1 neurons causally enhances muscle-specific motor resonance in M1. Our study sheds light on the plastic mechanisms that shape AON functionality and demonstrates that exogenous manipulation of AON connectivity can influence basic mirror mechanisms that underlie social perception.